LANDLORD AFFIDAVIT OF RESIDENCE

Landlord’s Name [NAME OF LANDLORD]

Street Address [STREET ADDRESS OF LANDLORD]
City, State [CITY AND ABBREVIATED STATE OF LANDLORD]
Zip [ZIP CODE OF LANDLORD]

Date [DATE]

To Whom This May Concern,

I, [NAME OF LANDLORD], the landlord of [NAME OF TENANT] formally acknowledge that

he/she resides at the street address of [STREET ADDRESS OF TENANT], City of [CITY OF
TENANT], State of [STATE OF TENANT] since [DATE TENANCY BEGAN] as my tenant.

Furthermore, I swear and affirm under penalty of perjury that the facts set forth in this statement
are true and accurate.

Sincerely,

_____________________

Witness Acknowledgment
I/We, as witness(es) to the aforementioned claims made by [NAME OF AFFIANT] and

acknowledge their residency status.

Witness Signature _____________________ Date _________________

Print Name [NAME OF WITNESS]

Witness Signature _____________________ Date _________________

Print Name [NAME OF WITNESS]

Notary Acknowledgment

A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of [STATE OF NOTARY]

County of [COUNTY OF NOTARY]

On [DATE], before me, [NAME OF NOTARY PUBLIC], Notary Public, personally appeared

[NAME OF AFFIANT] who proved to me on the basic of satisfactory evidence to be the

person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me

that he/she/they executed the same in his/her/their authorized capacity(ies), and that by

his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the

person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of in the State of [STATE OF NOTARY]

that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature _____________________
Place Notary Seal Above Print Name [NAME OF NOTARY PUBLIC]